1. California Senate Bill 132, a bill to establish educational and training requirements for sleep technologists, was introduced into the General Assembly on February 9. SB 132 is the same as the measure Governor Schwarzenegger vetoed last year in response to a protracted and contentious debate over the California state budget. The Governor chose to veto SB 1526 along with 137 other bills in order to send a message to the state legislature. The Governors veto was completely unrelated to the merits of the bill, which had passed the legislature with a significant bipartisan majority.

2. Hawaii On January 28, 2009, nine bills pertaining to licensing requirements for respiratory care practitioners were introduced in the Hawaii State Legislature. Iowa On January 7, the BRPT submitted a letter to the IRBC requesting that the Board approve the BRPT as a testing body in the state of Iowa. On February 16, the IRBC sent a letter to the BRPT informing them that the Board approves the BRPT as a testing body offering the examination for awarding the credential of Registered Polysomnographic Technologist. Maryland Senate Bill 433 would postpone the initial licensure deadline for sleep technologists from October 1, 2009 until 2012, in response to a letter from the Maryland Board of Physicians that implementation of the October 1, 2009 licensure deadline would lead to either a significant decrease in the availability of sleep studies in Maryland, or to a large pool of unlicensed personnel practicing in spite of the law.

3. Minnesota Recently Senate Bill 685 (SF 685) was introduced into the Minnesota Legislature. The bill amends the Respiratory Care Practice Act by changing the conditions for respiratory therapists from registered to licensed. However, the legislation also modifies the exemption language for sleep technologists. sleep technologists would be required to first pass the BRPT exam before they are allowed to work in a sleep facility. Tennessee The American Association for Respiratory Care has introduced Senate Bill 726, to amend the Polysomnographic Practice Act by: requiring that licensed sleep technologists and technicians work under the direct supervision of a licensed physician; eliminating the Accredited Sleep Technologist Programs (A-STEP) in the state; and by eliminating the ability of a sleep technologist to provide education of a patient regarding the treatment regimen that assists the patient in improving the patients sleep.

4. MEDICAL BOARD NEWSLETTER APRIL 2008 Clarification to the CPAP Language Individuals must be licensed in order to provide care planning, provide education to the patient or family or to size an interface device for a CPAP or BiPap device with or without oxygen. GEORGIA COMPOSITE STATE BOARD OF MEDICAL EXAMINERS MINUTES NOVEMBER 1, 2007 Regarding a question concerning CPAP-Does an individual need to hold licensure in the state to perform education, to patients, concerning applying a nasal mask or interface for a CPAP device? Approved to refer back to the Committee to review at the December Committee Meeting, and request Larry Arnson to draft letter for Committees review.

5. MEDICAL BOARD NEWSLETTER -- November 2008 Respiratory Care Advisory Committee

6. AASM Letter December 2, 2008 Jean Sumner, M.D., President Georgia Composite State Board of Medical Examiners 2 Peachtree Street, N.W. 36th Floor Atlanta, Georgia 30303-3465 Re: Status of Registered Polysomnographic Technologists and the Practice of Respiratory Care Dear Dr. Sumner: The American Academy of Sleep Medicine (AASM) views with great alarm the steps being taken by your Advisory Committee on Respiratory Care that will have the effect of arbitrarily expanding the scope of respiratory care practice in a manner that will inhibit the ability of polysomnographic technologists to continue their well- established patient care work. As we have seen from the minutes from the Boards November 1 meeting and the November issue of the Medical Board Newsletter, actions are underway to expand the regulatory language set out in Board Rule 360.13.12(2)(g) in a manner that will unduly define the work of sleep technologists as respiratory care. While a qualified respiratory care therapist (RT) who has completed additional schooling/training may be qualified to sit for the BRPT examination, the fact is that the vast majority of the 13,000 individuals who have taken this examination and who work in sleep centers in Georgia and throughout the country do not have a respiratory care background.

7. Even an advanced respiratory therapist who holds the RRT credential must have additional education or training to sit for the new examination being offered for the first time next January by the National Board for Respiratory Care (NBRC) to qualify as a sleep disorder specialist. However, few educational programs, including the baccalaureate and masters RT programs at the Georgia State University College of Health and Human Sciences School of Health Professions, currently offer the add-on courses necessary for a RT to be eligible to take the NBRC sleep disorder specialist examination. The AASM urges you to take the time necessary to fully understand the implications of any action to formalize a position that could result is significant access to care roadblocks for patients seeking care from a Georgia sleep center by arbitrarily determining that sleep technologists who are not also qualified as RTs are violating the law in every instance where they are providing quality care involving CPAP or related therapy. In light of this and the reality of hundreds of qualified personnel who have been providing Georgians with this care for decades as well as currently, we urge you to delay any determinations on this issue until there has been an open and complete airing of the information scheduled to be presented in response to the Other Business identified at the November meeting. The AASM hopes that time will be allowed at a future meeting to provide detailed information on the work and care routinely provided by sleep technologists. If anything, the fact that sleep technologists are not currently licensed in Georgia speaks to the need to follow the lead taken in Louisiana, Maryland, New Jersey, New Mexico and Tennessee where sleep technologist licensure has been established.

10. SB 252 - Polysomnography Practice Act A BILL to amend Chapter 34 of Title 43 of the Official Code of Georgia Annotated, relating to physicians, physician's assistants, and others, so as to provide for the certification of polysomnographic technologists; to provide a short title; to provide legislative findings; to provide for definitions; to provide for applications to be made to the Composite State Board of Medical Examiners to obtain certification to practice polysomnography; to provide for powers and duties of the board; to provide for certification standards and requirements; to provide for the issuance and renewal of certification; to provide for permitted and prohibited activities; to provide for related matters; to provide for an effective date; to repeal conflicting laws; and for other purposes.

11. Funding for Fraud and Abuse Enforcement 2010 Budget Proposal: Scheduled Medicare spending cuts of about 21% in 2010 and about 5% in each of the next few years will be eliminated. Additional $311 million in spending will be added for efforts to reduce Medicare and Medicaid fraud. STIMULUS - OIG: The HHS Office of the Inspector General receives $17,000,000 which shall remain available until September 30, 2012. 2009 OIG Work Plan We will examine the factors contributing to the rise in Medicare payments for sleep studies and assess provider compliance with Federal program requirements.

12. OIG Compliance Program for Individual and Small Group Physician Practices (Published in Federal Register, October 5, 2000) Seven components of a voluntary compliance program: 1.Conducting internal monitoring and auditing; 2.Implementing compliance and practice standards; 3.Designating a compliance officer or contact; 4.Conducting appropriate training and education; 5.Responding appropriately to detected offenses and developing corrective action; 6.Developing open lines of communication; and 7.Enforcing disciplinary standards through well-publicized guidelines.

13. State Society Update The purpose of the sleep society initiative is to strengthen the sleep care community in the state, and to provide a forum that will serve to educate members and protect the profession from any issues that may affect their practice. At the start of this initiative there were 18 state sleep societies, including Georgia. Currently there are 28 societies. AASM currently is working with 10 new states.